{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T07:54:57Z","timestamp":1769586897587,"version":"3.49.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2026,1,11]]},"abstract":"<jats:p>\n                    Ring-enhancing brain lesions present a common radiological conundrum, especially in immunocompetent hosts where there is a broad differential diagnosis.\n                    <jats:italic>Toxoplasma gondii,<\/jats:italic>\n                    an obligate intracellular protozoan, typically causes encephalitis in immunocompromised patients, especially those with HIV\/AIDS. Toxoplasma cerebral lesions in apparently immunocompetent people pose a diagnostic dilemma. The clinical features may mimic neoplastic or fungal causes, particularly when there are atypical radiological and histological presentations. We report an immunocompetent patient with toxoplasma encephalitis causing multiple cerebral lesions, with persistent clinical deterioration, ambiguous radiological findings and delayed response to treatment. The case emphasises the importance of tissue diagnosis and multidisciplinary management in this condition.\n                  <\/jats:p>","DOI":"10.1136\/pn-2025-004914","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:20:30Z","timestamp":1769538030000},"page":"pn-2025-004914","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ring-enhancing lesions in an immunocompetent patient"],"prefix":"10.1136","author":[{"given":"Vaibhav","family":"Bhandari","sequence":"first","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M C","family":"Sharma","sequence":"additional","affiliation":[{"name":"Neuropathology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Garg","sequence":"additional","affiliation":[{"name":"Neuro Radiology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aneesh","family":"Joshi","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwinee","family":"Kumar","sequence":"additional","affiliation":[{"name":"Neuropathology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhavi","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Nuclear Medicine, All india Institute of Medical Sciences, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmine","family":"Parihar","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-7526","authenticated-orcid":false,"given":"Deepti","family":"Vibha","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh K","family":"Singh","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manjari","family":"Tripathi","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arunmozhimaran","family":"Elavarasi","sequence":"additional","affiliation":[{"name":"Neurology, All India Institute of Medical Sciences Neurosciences Centre, New Delhi, DL, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012710202183000_pn-2025-004914v1.1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.2176\/nmc.40.120","article-title":"Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome--four case reports","volume":"40","author":"Nakazaki","year":"2000","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"2026012710202183000_pn-2025-004914v1.2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/aian.AIAN_70_18","article-title":"Practice Trends in Treating Central Nervous System Tuberculosis and Outcomes at a Tertiary Care Hospital: A Cohort Study of 244 Cases","volume":"22","author":"Goyal","year":"2019","journal-title":"Ann Indian Acad Neurol"},{"key":"2026012710202183000_pn-2025-004914v1.3","doi-asserted-by":"crossref","first-page":"101509","DOI":"10.1016\/j.tmaid.2019.101509","article-title":"Severe toxoplasmosis imported from tropical Africa in immunocompetent patients: A case series","volume":"35","author":"Leroy","year":"2020","journal-title":"Travel Med Infect Dis"},{"key":"2026012710202183000_pn-2025-004914v1.4","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/15.2.211"},{"key":"2026012710202183000_pn-2025-004914v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16412-X"},{"key":"2026012710202183000_pn-2025-004914v1.6","first-page":"E76","article-title":"Toxoplasma encephalitis in HIV-negative patients","volume":"19","author":"Antinori","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"2026012710202183000_pn-2025-004914v1.7","doi-asserted-by":"crossref","unstructured":"Elsheikha HM , Marra CM , Zhu XQ . Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis. Clin Microbiol Rev 2021;34. doi:10.1128\/CMR.00115-19","DOI":"10.1128\/CMR.00115-19"},{"key":"2026012710202183000_pn-2025-004914v1.8","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.05013-11"},{"key":"2026012710202183000_pn-2025-004914v1.9","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/22.2.268"},{"key":"2026012710202183000_pn-2025-004914v1.10","first-page":"561","article-title":"New pathogens and mode of action of azithromycin: Toxoplasma gondii","volume":"43","author":"Derouin","year":"1995","journal-title":"Pathol Biol (Paris)"},{"key":"2026012710202183000_pn-2025-004914v1.11","doi-asserted-by":"crossref","unstructured":"Montazeri M , Mehrzadi S , Sharif M , et al . Drug Resistance in Toxoplasma gondii. Front Microbiol 2018;9. doi:10.3389\/fmicb.2018.02587","DOI":"10.3389\/fmicb.2018.02587"},{"key":"2026012710202183000_pn-2025-004914v1.12","doi-asserted-by":"crossref","unstructured":"Shapiro K , Bahia-Oliveira L , Dixon B , et al . Environmental transmission of Toxoplasma gondii: Oocysts in water, soil and food. Food Waterborne Parasitol 2019;15. doi:10.1016\/j.fawpar.2019.e00049","DOI":"10.1016\/j.fawpar.2019.e00049"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2025-004914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:20:32Z","timestamp":1769538032000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2025-004914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":12,"alternative-id":["10.1136\/pn-2025-004914"],"URL":"https:\/\/doi.org\/10.1136\/pn-2025-004914","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}